Diagnosis and Treatment

The diagnosis must be initiated immediately on noticing any suspicious lumps or nodules in the breast. Initially, the symptoms, social habits, medical history, menstrual and reproductive history and family history of the patient are reviewed. A physical examination is done to identify lumps and observe any changes in the breast’s size, shape, and colour.

To confirm the diagnosis, the patient is recommended to undergo the following tests:

Imaging tests: These help to identify the stage and extent of breast cancer, and may include the following:

  • Mammograms: A mammogram uses low-dose x-rays to screen breast cancer. It helps in locating the lumps and identifying any other breast abnormalities.
  • Digital Tomosynthesis or 3D mammography- This kind of imaging is a test that combines multiple breast X rays to breast a three dimensional picture of the breast. It increases the detection of breast cancer by approximately 25% and decreases the false positive call backs.
  • Breast ultrasound: Breast ultrasound uses sound waves to produce internal images of the breasts. It helps to detect any lumps or abnormalities in breasts and distinguish cancerous solid mass from a non-cancerous fluid-filled cyst or other kinds of lumps..
  • Breast MRI: MRI involves using powerful magnetic fields to create images of the breast to identify lumps that are not visible with other imaging tests. It is mostly recommended in women with dense breast tissue.

Biopsy: During biopsy, a small sample of breast tissue is collected and examined in the laboratory to determine any abnormalities. Fine-needle aspiration, core biopsy, and open biopsy are some types of biopsies based on the type of technique used to collect the tissue sample.

Stages of breast cancer:

Cancer staging is performed using the TNM system to get a detailed information about:

  • Tumour (T): Whether the primary tumour has grown through the breast
  • Node (N): Whether cancer has spread to the surrounding lymph nodes
  • Metastasis (M): Whether cancer has spread to distant organs

Based on TNM staging, breast cancer is divided into the following stages:

  • Stage 0a/0is: cancer cells are confined only in the ducts of the breast tissue, they have not spread to the surrounding breast tissue.
  • Stage 1: the size of the tumour is up to 2 cm and is confined only to the breast.
  • Stage 2: the tumour size is 2 to 4 cm and cancer could have spread to surrounding lymph nodes or the tumour is larger than 5cms but no spread to the axillary nodes or the there is no tumour in the breast but only in the lymph nodes. .
  • Stage 3: the tumour size is > 5 cm and cancer has spread to the chest wall or surrounding tissues and surrounding lymph nodes or the tumour is less than 5cms with large nodes in the armpit. .
  • Stage 4: cancer has spread to distant organs of the body.

Treatment for breast cancer

The treatment aims to remove as much as cancer possible and to prevent the recurrence. Based on the type, size, and extent of cancer, the following treatment modalities are recommended:

Breast cancer surgery:

Surgery is done to remove the tumour and some surrounding healthy tissue. It is usually recommended for early-stage breast cancers that are small in size.

Breast cancer surgery is of the following types:

  1. Lumpectomy: This procedure involves the removal of the tumour and some surrounding tissue while leaving the rest of the breast intact. In the case of invasive cancer and some cases of in-situ cancer, radiation therapy is recommended after the surgery to kill the remaining cancer cells.
  2. Mastectomy: It involves the complete removal of breast tissue. . In some cases, a double mastectomy is needed, wherein both breasts are removed.
  3. Sentinel node biopsy: This procedure is recommended if the cancer has spread beyond the primary tumour. In this procedure, the sentinel (first node) lymph nodes are located and removed. These nodes are further examined in the laboratory to look for any abnormalities. This procedure is done using a radioactive dye and a blue dye.
  4. Axillary lymph node dissection: In this procedure, the lymph nodes from the armpit are removed. This procedure is recommended when sentinel lymph nodes contain cancer or the nodes have been involved with cancer.
  5. Breast reconstruction: This procedure involves rebuilding the shape of the breast after mastectomy.

Radiation therapy can be given in two ways to treat breast cancer. These includes:

External beam radiation therapy: It is the most common type of radiation therapy to treat breast cancer. In this therapy, high-powered radiation beams are delivered precisely on the affected area through a machine outside the body.

Brachytherapy: After surgical removal of the tumour, a device containing radioactive source is implanted temporarily into the breast tissue near the tumour site. This device emits high dose of radiation to the surrounding tissue, close to the original tumour, hence preventing the recurrence. However, based on the size, location, and other factors, the doctor may decide whether the patient requires brachytherapy or not.

Chemotherapy: It uses specific powerful drugs that interfere with the process of cell division and promote cancer cell death. Not all women with breast cancer require chemotherapy, however, it is recommended before the surgery to shrink a tumour or after the surgery/ radiation therapy to kill the remaining cancer cells, and in the advanced stage to control the spread. Chemotherapy can be given orally or through intravenous administration.

Hormone therapy: It is recommended in the treatment of breast cancers that are sensitive to hormones, such as estrogen or progesterone. Hormone therapy acts by either decreasing the production of hormones or blocking them from working. It can be given before or after the surgery to shrink a tumour and to lower the risk of recurrence.

Targeted Therapy: It uses specific drugs or substances that target specific characteristic of cancer cells. Targeted therapy is recommended in certain cases where breast cancer cells overexpress certain characteristic of proteins on the cancer cell surface, thereby promoting the abnormal growth pattern.

Immunotherapy: Immunotherapy involves the usage of certain medicines to boost a person’s immune system to find and destroy the cancer cells. Immunotherapies, such as atezolizumab and pembrolizumab are among the few FDA approved drugs for breast cancer treatment.

Patient Resources

Breast Cancer

Types of Breast Cancer

Symptoms and Causes

Prevention

Myths and Facts

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